Luca Di Maurizio | Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) (original) (raw)

Papers by Luca Di Maurizio

PubMed, May 1, 2019

With our study, we searched the medical literature to find magnesium (Mg) correlation with Emerge... more With our study, we searched the medical literature to find magnesium (Mg) correlation with Emergency situations or its use in Emergency Medicine. Our aim is to fill the gap that we find in our daily routine between Mg studies on its role in Emergency and the real conception that doctors have of it in medical practice. We searched the literature for terms as magnesium or magnesium sulphate, magnesium in emergency, eclampsia, arrhythmias, acute asthma exacerbation, magnesium, and pediatric population. After a thorough research, we divided our discoveries into chapters to sort out a large amount often discordant articles.

Seminars in Liver Disease, May 1, 2018

In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) ... more In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) for a variety of liver conditions has exponentially grown. We performed a thorough search for all available studies on the performance of diagnostic and therapeutic EUS in the field of hepatology. This article reviews the indication of EUS in the evaluation and treatment of portal hypertension, portal vein pressure measurement, focal liver lesions, and parenchymal liver diseases, and presents all the clinical evidences available so far in this regard. All the review data suggest that EUS is becoming an increasingly important tool in the armamentarium of the hepatologists for the management of certain liver-related conditions. Implementation in the education of the hepatologists of means to become more familiar with both diagnostic and therapeutic capabilities of EUS is warranted.

Gastroenterology, May 1, 2010

Purpose: Celiac crisis is a life-threatening syndrome where celiac disease presents with profuse ... more Purpose: Celiac crisis is a life-threatening syndrome where celiac disease presents with profuse diarrhea and severe metabolic disturbances. Celiac crisis in adults is believed to be uncommon and is not well documented. However, it is likely that many patients with celiac crisis are not definitively diagnosed. In order to improve awareness and to facilitate diagnosis, we reviewed cases of celiac crisis seen at Beth Israel Deaconess Medical Center in Boston, MA and Mayo Clinic in Rochester, MN. These data were used to identify presenting features, formulate diagnostic criteria for celiac crisis in adults and develop treatment strategies. Methods: We reviewed cases of biopsy proven celiac disease in the last 5 years. Celiac crisis was defined as acute onset or rapid progression of gastrointestinal symptoms attributable to celiac disease requiring hospitalization and/or parenteral nutrition along with at least 2 of the 7 factors listed below: 1.Signs of severe dehydration including hemodynamic instability or orthostasis 2.Neurologic dysfunction 3.Renal dysfunction: creatinine >2.0 4.Metabolic acidosis: pH <7.35 5.Hypoproteinemia (Albumin < 3.0) 6.Significant electrolyte abnormalities: Na, Ca, K, or Mg 7.Weight loss > 10 lbs Results: Twelve patients met the above criteria. Of these, 8 were women and 4 were men. 11 developed celiac crisis prior to diagnosis of celiac disease. IgA tissue transglutaminase titer was available for 11 patients. Of these, one had IgA deficiency, and all of the others had elevated tTG, eight with levels greater than 4 times the normal limits. Biopsies of the duodenum in all patients were consistent with a Marsh 3 score. HLA type was available for 10, of which 9 were positive for DQ2 and 1 for DQ8. Patients presented with severe dehydration, renal dysfunction, and electrolyte disturbances, of which hypocalemia was most common. All patients required hospitalization and intravenous fluids and five required parenteral nutrition. Six patients required corticosteroids. All patients had a rapid clinical response to gluten free diet. Conclusion: Celiac crisis is associated with high morbidity and although rarely described, does occur in adults, often without a clear precipitating factor. Patients presenting with severe unexplained diarrhea and malabsorption should be tested for celiac disease and treatment with systemic steroids or oral budesonide considered. Nutritional support is often required in the short term but most patients ultimately respond to gluten avoidance. We are hopeful that our delineation of formal diagnostic criteria for celiac crisis will aid in identification and management of these patients.

Journal of Translational Medicine, Jul 11, 2015

Background: The intestinal stem cells (ISC) modulation and the role of circulating hematopoietic ... more Background: The intestinal stem cells (ISC) modulation and the role of circulating hematopoietic stem cells (HSC) in coeliac disease (CD) are poorly understood. Our aim was to investigate the longitudinal modifications in peripheral blood HSC traffic and putative ISC density induced by gluten-free diet (GFD) in CD. Methods: Thirty-one CD patients and 7 controls were enrolled. Circulating CD133 + and CD34 + HSC were measured by flow cytometry, at enrolment and after 7 days and 1, 3, 6, 12, and 24 months of GFD. Endoscopy was performed at diagnosis and repeated at 6, 12, and 24 months following GFD. We used the Marsh-Oberhuber score to evaluate the histological severity of duodenal damage; immunohistochemistry was employed to measure the intraepithelial lymphoid infiltrate (IEL, CD3 + lymphoid cells) and the putative ISC compartment (CD133 + and Lgr5 + epithelial cells). Results: At enrolment, circulating HSCs were significantly increased in CD patients and they further augmented during the first week of GFD, but progressively decreased afterwards. CD patients presented with villous atrophy, abundant IEL and rare ISC residing at the crypt base. Upon GFD, IEL progressively decreased, while ISC density increased, peaking at 12 months. After 24 months of GFD, all patients were asymptomatic and their duodenal mucosa was macroscopically and histologically normal. Conclusions: In active CD patients, the ISC niche is depleted and there is an increased traffic of circulating HSC versus non-coeliac subjects. GFD induces a precocious mobilization of circulating HSC, which is followed by the expansion of the local ISC compartment, leading to mucosal healing and clinical remission.

Digestive and Liver Disease, May 1, 2018

Objective: Procurement of tissue core biopsy may overcome some of the limitations of EUS-FNA. We ... more Objective: Procurement of tissue core biopsy may overcome some of the limitations of EUS-FNA. We aimed at assessing the safety, core procurement yield and diagnostic accuracy of two novel available histology needles. Methods: Data from consecutive patients with solid lesions who underwent EUS-FNB using the 25G-22G SharkCore TM needles were retrieved from 4 tertiary-care centers database. Results: 146 patients (mean age 64 ± 12 years; M/F, 76/68) with 156 lesions (114 pancreatic) were identified. In 83 cases the 22G needle was used. 3.6 ± 1.2 passes per lesion were performed, without any major complications. A core biopsy was procured in 89.1% of cases. Considering malignant vs. non-malignant disease, the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 90.2% (95% CI, 83.7-94.3), 100% (95% CI, 87.2-100), 0.099 (95% CI, 0.058-0.170), 60.4 (95% CI, 3.86-947.4), and 92.3% (95% CI, 88.1-96.5). Procurement yield was significantly higher for the 22G (95.2% vs. 82.2%, p = 0.011), despite the fact that more needle passes were performed with the 25G needle (3.8 ± 1.3 vs. 3.4 ± 1.0, p = 0.028). Conclusions: EUS-FNB using the 25G-22G SharkCore TM needles is able to reach a very good procurement yield and diagnostic accuracy. The 22G-size needle showed superior core procurement and diagnostic capabilities. Large prospective studies are warranted to further evaluate the use of these types of needles.

Digestive and Liver Disease, Mar 1, 2011

Gastroenterology, May 1, 2010

through Matrigel compared with SW480 cells transfected with non-targeting control shRNA. CONCLUSI... more through Matrigel compared with SW480 cells transfected with non-targeting control shRNA. CONCLUSIONS. Knockdown of AKT1 in SW480 cells induces EMT formation and promotes cell invasion by downregulating and disrupting E-cadherin expression. Since AKT2 has been implicated in the promotion of CRC cell metastasis, our current study suggests that AKT1 and AKT2 play distinct roles in regulating CRC cell metastasis, thus providing a better understanding of the important and distinct functions of AKT isoforms during CRC progression.

Endoscopic ultrasound, 2018

Background and Objectives: Procurement of tissue core biopsy samples may overcome some of the lim... more Background and Objectives: Procurement of tissue core biopsy samples may overcome some of the limitations of endoscopic ultrasound (EUS)-guided fine-needle aspiration. We aimed at assessing the safety, histological sample procurement yield, and diagnostic accuracy of a newly available histology needle. Materials and Methods: Data from consecutive patients with pancreatic solid lesions who underwent EUS-fine needle biopsy (EUS-FNB) using the 22-gauge Acquire ™ needle were retrospectively retrieved from four tertiary care centers database. Results: Fifty-nine patients (mean age 68 ± 12 years; male/female 29/30) with pancreatic solid lesions underwent EUS-FNB using the 22-gauge Acquire ™ needle. The biopsy was done transgastrically in 22 (37.3%) patients and transduodenally in 37 (62.7%) cases. A mean of 2.8 ± 0.45 needle passes per lesion site were performed, without any major complication. A tissue core biopsy sample for histological evaluation was obtained in 55 (93.2%) cases. In the additional four cases, the specimen obtained resulted adequate for cytological evaluation. Considering malignant versus nonmalignant disease, sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 98.2% (95% confidence interval [CI], 90.6-99.7), 100% (95% CI, 43.6-100), 0.018 (95% CI, 0.003-0.125), 295.6 (95% CI, 0-9.3 × 10 10), and 98.3% (95% CI, 94.9-100), respectively. Conclusions: EUS-FNB using the 22-gauge Acquire ™ needle is able to reach a very high procurement yield and diagnostic accuracy. Large prospective studies are warranted to further evaluate the utility of this newly developed needle.

Digestive and Liver Disease, Mar 1, 2010

European review for medical and pharmacological sciences, 2019

With our study, we searched the medical literature to find magnesium (Mg) correlation with Emerge... more With our study, we searched the medical literature to find magnesium (Mg) correlation with Emergency situations or its use in Emergency Medicine. Our aim is to fill the gap that we find in our daily routine between Mg studies on its role in Emergency and the real conception that doctors have of it in medical practice. We searched the literature for terms as magnesium or magnesium sulphate, magnesium in emergency, eclampsia, arrhythmias, acute asthma exacerbation, magnesium, and pediatric population. After a thorough research, we divided our discoveries into chapters to sort out a large amount often discordant articles.

Digestive and Liver Disease, 2017

in 3 of those patients considering the final diagnosis as possible "false negative". Based on the... more in 3 of those patients considering the final diagnosis as possible "false negative". Based on these results the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 93.6% (95% CI, 81.4-98.3), 100% (95% CI, 54.6-100), 0.063 (95% CI, 0.021-0.190), "infinity" (final value >10 with 95% CI not calculable), and 94% (95% CI, 89.1-98.5), respectively. No adverse events were recorded. Conclusions: The 22G Acquire™ needles are able to gather tissue for EUS-FNTA of solid lesions with very good procurement and diagnostic yields after 2 or 3 needle passes. This novel "three points-tip" needle showed very high level of sensitivity, specificity and diagnostic accuracy, with a safe post-biopsy profile.

Digestive and Liver Disease, 2014

s of the 20 th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S... more s of the 20 th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1-S144 been used as efficacy parameter of PE. To evaluate PE safety, complications during treatment have been considered. Results: 70 pts with liver failure (11 acute, 37 acute on chronic, 22 chronic) have been submitted to PE (6.4±7.8 sessions/patient in 1.4±0.8 months/patient). PE has been stopped in 28 pts (40.0%) for permanent reduction of bilirubin under 15 mg/dL; in 22 pts (31.4%) for worsening or death; in 4 pts (5.7%) for liver transplantation; in 13 pts (18.6%) for severe complication (hypotension, sepsis, hemorrhagic syndrome); 3 pts (4.3%) instead passed to MARS. There were no death linked to PE. Total bilirubin value at the end of treatment was 25.4±13.8 mg/dL vs 37.9±10.4 mg/dL at beginning (p=10-8). Among pts with a favorable outcome and those with unfavorable have been reported significant differences in term of age (48.0±14.9 vs 60.2±12.0, p=0.0005), MELD score (25.5±5.5 vs 32.2±7.3, p=0.00004), Child-Pugh score (9.4±1.8 vs 11.1±1.7, p=0.0002), presence of encephalopathy (17.5 vs 63.3% p=0.0001). Conclusions: In our study, PE resulted to be well tolerated and effective in the reduction of bilirubin value in 40% of pts with severe liver failure. Older Age, MELD>30, class C of Child-Pugh and presence of encephalopathy seems to be associated to a minor effectiveness of treatment. Despite the obtained results are indicative of efficacy of PE in an elevated percentage of pts, the retrospective nature of the study and the absence of a control group does not allow a definitive judgment.

Digestive and Liver Disease, 2010

Journal of Clinical Medicine

Several studies have suggested the potential role of Magnesium Sulfate (MgSO4) for the treatment ... more Several studies have suggested the potential role of Magnesium Sulfate (MgSO4) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of magnesium is not standardized although it is largely used for the treatment of supraventricular arrhythmias. Objectives. We evaluated the role of MgSO4 infusion in association with flecainide in cardioversion of patients presenting in ED with symptomatic AF started less than 48 h before. We retrospectively searched for all patients presented in ED from 1 January 2019 to 31 December 2019 requiring pharmacological cardioversion with flecainide 2 mg/kg. Ninety-seven patients met these criteria, 46 received the administration of intravenous MgSO4 2 gr (Group A), and 51 did not (Group B). Among the 97 patients, the overall cardioversion rate was 85.6%, 91.3% in Group A and 80.4% in Group B. In 27 patients out of 97, the Flecainide was not administered because of spontaneous restoration of sinus rhythm of 9 pts (Group B) and 18 ...

International Journal of Clinical Practice, 2021

The COVID‐19 pandemic represents a source of stress and potential burnout for many physicians. Th... more The COVID‐19 pandemic represents a source of stress and potential burnout for many physicians. This single‐site survey aimed at assessing perceived stress and risk to develop burnout syndrome among physicians operating in COVID wards.

Digestive and Liver Disease, 2010

Internal and Emergency Medicine, 2021

Introduction Antibody response plays a fundamental role in the natural history of infectious dise... more Introduction Antibody response plays a fundamental role in the natural history of infectious disease. A better understanding of the immune response in patients with SARS-CoV-2 infection could be important for identifying patients at greater risk of developing a more severe form of disease and with a worse prognosis. Methods We performed a cross-sectional analysis to determine the presence and the levels of both anti-SARS-CoV-2 IgG and IgA in a cohort of hospitalized patients with confirmed infection at different times in the natural history of the disease. Patients enrolled when admitted at the emergency department were prospectively followed up during hospital stay. Results Overall, 131 patients were considered with a total of 237 samples processed. Cross-sectional analysis showed that seroconversion for IgA seems to occur between days 6 and 15, while IgG response seems to occur slightly later, peaking at day 20 after symptoms onset. Both IgA and IgG were maintained beyond 2 months. Severe patients showed a higher IgA response compared with mild patients when analyzing optical density (8.3 versus 5.6, p < 0.001). Prospective analysis conducted on 55 patients confirmed that IgA appear slightly earlier than IgG. After stratifying for the severity of disease, both the IgA and IgG responses were more vigorous in severe cases. Moreover, while IgG tended to stabilize, there was a relevant decline after the first month of IgA levels in mild cases. Conclusion IgA and IgG antibody response is closely related, although seroconversion for IgA occurs earlier. Both IgA and IgG are maintained beyond 2 months. Severe patients showed a more vigorous IgA and IgG response. IgA levels seem to decline after 1 month since the onset of symptoms in mild cases. Our results should be interpreted with cautions due to several limitations in our study, mainly the small number of cases, lack of data on viral load and clinical setting.

IntroductionAntibody response play a fundamental role in the natural history of infectious diseas... more IntroductionAntibody response play a fundamental role in the natural history of infectious disease. A better understanding of the immune response in patients with SARS-CoV-2 infection could be important for identifying patients at greater risk of developing a more severe form of disease and with a worse prognosis.MethodsWe performed a cross-sectional analysis to determine the presence and the levels of both anti-SARS-CoV-2 IgG and IgA in a cohort of hospitalized patients with confirmed infection at different times in the natural history of the disease. Patients enrolled when admitted at the emergency department were prospectively followed up during hospital stay.ResultsOverall, 131 patients were considered with a total of 237 samples processed. Cross-sectional analysis showed that seroconversion for IgA seems to occur between days 5 and 15 while IgG response seems to occur slightly later, peaking at day 20 after symptoms onset. Both IgA and IgG were maintained beyond two months. Sev...

PubMed, May 1, 2019

With our study, we searched the medical literature to find magnesium (Mg) correlation with Emerge... more With our study, we searched the medical literature to find magnesium (Mg) correlation with Emergency situations or its use in Emergency Medicine. Our aim is to fill the gap that we find in our daily routine between Mg studies on its role in Emergency and the real conception that doctors have of it in medical practice. We searched the literature for terms as magnesium or magnesium sulphate, magnesium in emergency, eclampsia, arrhythmias, acute asthma exacerbation, magnesium, and pediatric population. After a thorough research, we divided our discoveries into chapters to sort out a large amount often discordant articles.

Seminars in Liver Disease, May 1, 2018

In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) ... more In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) for a variety of liver conditions has exponentially grown. We performed a thorough search for all available studies on the performance of diagnostic and therapeutic EUS in the field of hepatology. This article reviews the indication of EUS in the evaluation and treatment of portal hypertension, portal vein pressure measurement, focal liver lesions, and parenchymal liver diseases, and presents all the clinical evidences available so far in this regard. All the review data suggest that EUS is becoming an increasingly important tool in the armamentarium of the hepatologists for the management of certain liver-related conditions. Implementation in the education of the hepatologists of means to become more familiar with both diagnostic and therapeutic capabilities of EUS is warranted.

Gastroenterology, May 1, 2010

Purpose: Celiac crisis is a life-threatening syndrome where celiac disease presents with profuse ... more Purpose: Celiac crisis is a life-threatening syndrome where celiac disease presents with profuse diarrhea and severe metabolic disturbances. Celiac crisis in adults is believed to be uncommon and is not well documented. However, it is likely that many patients with celiac crisis are not definitively diagnosed. In order to improve awareness and to facilitate diagnosis, we reviewed cases of celiac crisis seen at Beth Israel Deaconess Medical Center in Boston, MA and Mayo Clinic in Rochester, MN. These data were used to identify presenting features, formulate diagnostic criteria for celiac crisis in adults and develop treatment strategies. Methods: We reviewed cases of biopsy proven celiac disease in the last 5 years. Celiac crisis was defined as acute onset or rapid progression of gastrointestinal symptoms attributable to celiac disease requiring hospitalization and/or parenteral nutrition along with at least 2 of the 7 factors listed below: 1.Signs of severe dehydration including hemodynamic instability or orthostasis 2.Neurologic dysfunction 3.Renal dysfunction: creatinine >2.0 4.Metabolic acidosis: pH <7.35 5.Hypoproteinemia (Albumin < 3.0) 6.Significant electrolyte abnormalities: Na, Ca, K, or Mg 7.Weight loss > 10 lbs Results: Twelve patients met the above criteria. Of these, 8 were women and 4 were men. 11 developed celiac crisis prior to diagnosis of celiac disease. IgA tissue transglutaminase titer was available for 11 patients. Of these, one had IgA deficiency, and all of the others had elevated tTG, eight with levels greater than 4 times the normal limits. Biopsies of the duodenum in all patients were consistent with a Marsh 3 score. HLA type was available for 10, of which 9 were positive for DQ2 and 1 for DQ8. Patients presented with severe dehydration, renal dysfunction, and electrolyte disturbances, of which hypocalemia was most common. All patients required hospitalization and intravenous fluids and five required parenteral nutrition. Six patients required corticosteroids. All patients had a rapid clinical response to gluten free diet. Conclusion: Celiac crisis is associated with high morbidity and although rarely described, does occur in adults, often without a clear precipitating factor. Patients presenting with severe unexplained diarrhea and malabsorption should be tested for celiac disease and treatment with systemic steroids or oral budesonide considered. Nutritional support is often required in the short term but most patients ultimately respond to gluten avoidance. We are hopeful that our delineation of formal diagnostic criteria for celiac crisis will aid in identification and management of these patients.

Journal of Translational Medicine, Jul 11, 2015

Background: The intestinal stem cells (ISC) modulation and the role of circulating hematopoietic ... more Background: The intestinal stem cells (ISC) modulation and the role of circulating hematopoietic stem cells (HSC) in coeliac disease (CD) are poorly understood. Our aim was to investigate the longitudinal modifications in peripheral blood HSC traffic and putative ISC density induced by gluten-free diet (GFD) in CD. Methods: Thirty-one CD patients and 7 controls were enrolled. Circulating CD133 + and CD34 + HSC were measured by flow cytometry, at enrolment and after 7 days and 1, 3, 6, 12, and 24 months of GFD. Endoscopy was performed at diagnosis and repeated at 6, 12, and 24 months following GFD. We used the Marsh-Oberhuber score to evaluate the histological severity of duodenal damage; immunohistochemistry was employed to measure the intraepithelial lymphoid infiltrate (IEL, CD3 + lymphoid cells) and the putative ISC compartment (CD133 + and Lgr5 + epithelial cells). Results: At enrolment, circulating HSCs were significantly increased in CD patients and they further augmented during the first week of GFD, but progressively decreased afterwards. CD patients presented with villous atrophy, abundant IEL and rare ISC residing at the crypt base. Upon GFD, IEL progressively decreased, while ISC density increased, peaking at 12 months. After 24 months of GFD, all patients were asymptomatic and their duodenal mucosa was macroscopically and histologically normal. Conclusions: In active CD patients, the ISC niche is depleted and there is an increased traffic of circulating HSC versus non-coeliac subjects. GFD induces a precocious mobilization of circulating HSC, which is followed by the expansion of the local ISC compartment, leading to mucosal healing and clinical remission.

Digestive and Liver Disease, May 1, 2018

Objective: Procurement of tissue core biopsy may overcome some of the limitations of EUS-FNA. We ... more Objective: Procurement of tissue core biopsy may overcome some of the limitations of EUS-FNA. We aimed at assessing the safety, core procurement yield and diagnostic accuracy of two novel available histology needles. Methods: Data from consecutive patients with solid lesions who underwent EUS-FNB using the 25G-22G SharkCore TM needles were retrieved from 4 tertiary-care centers database. Results: 146 patients (mean age 64 ± 12 years; M/F, 76/68) with 156 lesions (114 pancreatic) were identified. In 83 cases the 22G needle was used. 3.6 ± 1.2 passes per lesion were performed, without any major complications. A core biopsy was procured in 89.1% of cases. Considering malignant vs. non-malignant disease, the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 90.2% (95% CI, 83.7-94.3), 100% (95% CI, 87.2-100), 0.099 (95% CI, 0.058-0.170), 60.4 (95% CI, 3.86-947.4), and 92.3% (95% CI, 88.1-96.5). Procurement yield was significantly higher for the 22G (95.2% vs. 82.2%, p = 0.011), despite the fact that more needle passes were performed with the 25G needle (3.8 ± 1.3 vs. 3.4 ± 1.0, p = 0.028). Conclusions: EUS-FNB using the 25G-22G SharkCore TM needles is able to reach a very good procurement yield and diagnostic accuracy. The 22G-size needle showed superior core procurement and diagnostic capabilities. Large prospective studies are warranted to further evaluate the use of these types of needles.

Digestive and Liver Disease, Mar 1, 2011

Gastroenterology, May 1, 2010

through Matrigel compared with SW480 cells transfected with non-targeting control shRNA. CONCLUSI... more through Matrigel compared with SW480 cells transfected with non-targeting control shRNA. CONCLUSIONS. Knockdown of AKT1 in SW480 cells induces EMT formation and promotes cell invasion by downregulating and disrupting E-cadherin expression. Since AKT2 has been implicated in the promotion of CRC cell metastasis, our current study suggests that AKT1 and AKT2 play distinct roles in regulating CRC cell metastasis, thus providing a better understanding of the important and distinct functions of AKT isoforms during CRC progression.

Endoscopic ultrasound, 2018

Background and Objectives: Procurement of tissue core biopsy samples may overcome some of the lim... more Background and Objectives: Procurement of tissue core biopsy samples may overcome some of the limitations of endoscopic ultrasound (EUS)-guided fine-needle aspiration. We aimed at assessing the safety, histological sample procurement yield, and diagnostic accuracy of a newly available histology needle. Materials and Methods: Data from consecutive patients with pancreatic solid lesions who underwent EUS-fine needle biopsy (EUS-FNB) using the 22-gauge Acquire ™ needle were retrospectively retrieved from four tertiary care centers database. Results: Fifty-nine patients (mean age 68 ± 12 years; male/female 29/30) with pancreatic solid lesions underwent EUS-FNB using the 22-gauge Acquire ™ needle. The biopsy was done transgastrically in 22 (37.3%) patients and transduodenally in 37 (62.7%) cases. A mean of 2.8 ± 0.45 needle passes per lesion site were performed, without any major complication. A tissue core biopsy sample for histological evaluation was obtained in 55 (93.2%) cases. In the additional four cases, the specimen obtained resulted adequate for cytological evaluation. Considering malignant versus nonmalignant disease, sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 98.2% (95% confidence interval [CI], 90.6-99.7), 100% (95% CI, 43.6-100), 0.018 (95% CI, 0.003-0.125), 295.6 (95% CI, 0-9.3 × 10 10), and 98.3% (95% CI, 94.9-100), respectively. Conclusions: EUS-FNB using the 22-gauge Acquire ™ needle is able to reach a very high procurement yield and diagnostic accuracy. Large prospective studies are warranted to further evaluate the utility of this newly developed needle.

Digestive and Liver Disease, Mar 1, 2010

European review for medical and pharmacological sciences, 2019

With our study, we searched the medical literature to find magnesium (Mg) correlation with Emerge... more With our study, we searched the medical literature to find magnesium (Mg) correlation with Emergency situations or its use in Emergency Medicine. Our aim is to fill the gap that we find in our daily routine between Mg studies on its role in Emergency and the real conception that doctors have of it in medical practice. We searched the literature for terms as magnesium or magnesium sulphate, magnesium in emergency, eclampsia, arrhythmias, acute asthma exacerbation, magnesium, and pediatric population. After a thorough research, we divided our discoveries into chapters to sort out a large amount often discordant articles.

Digestive and Liver Disease, 2017

in 3 of those patients considering the final diagnosis as possible "false negative". Based on the... more in 3 of those patients considering the final diagnosis as possible "false negative". Based on these results the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 93.6% (95% CI, 81.4-98.3), 100% (95% CI, 54.6-100), 0.063 (95% CI, 0.021-0.190), "infinity" (final value >10 with 95% CI not calculable), and 94% (95% CI, 89.1-98.5), respectively. No adverse events were recorded. Conclusions: The 22G Acquire™ needles are able to gather tissue for EUS-FNTA of solid lesions with very good procurement and diagnostic yields after 2 or 3 needle passes. This novel "three points-tip" needle showed very high level of sensitivity, specificity and diagnostic accuracy, with a safe post-biopsy profile.

Digestive and Liver Disease, 2014

s of the 20 th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S... more s of the 20 th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1-S144 been used as efficacy parameter of PE. To evaluate PE safety, complications during treatment have been considered. Results: 70 pts with liver failure (11 acute, 37 acute on chronic, 22 chronic) have been submitted to PE (6.4±7.8 sessions/patient in 1.4±0.8 months/patient). PE has been stopped in 28 pts (40.0%) for permanent reduction of bilirubin under 15 mg/dL; in 22 pts (31.4%) for worsening or death; in 4 pts (5.7%) for liver transplantation; in 13 pts (18.6%) for severe complication (hypotension, sepsis, hemorrhagic syndrome); 3 pts (4.3%) instead passed to MARS. There were no death linked to PE. Total bilirubin value at the end of treatment was 25.4±13.8 mg/dL vs 37.9±10.4 mg/dL at beginning (p=10-8). Among pts with a favorable outcome and those with unfavorable have been reported significant differences in term of age (48.0±14.9 vs 60.2±12.0, p=0.0005), MELD score (25.5±5.5 vs 32.2±7.3, p=0.00004), Child-Pugh score (9.4±1.8 vs 11.1±1.7, p=0.0002), presence of encephalopathy (17.5 vs 63.3% p=0.0001). Conclusions: In our study, PE resulted to be well tolerated and effective in the reduction of bilirubin value in 40% of pts with severe liver failure. Older Age, MELD>30, class C of Child-Pugh and presence of encephalopathy seems to be associated to a minor effectiveness of treatment. Despite the obtained results are indicative of efficacy of PE in an elevated percentage of pts, the retrospective nature of the study and the absence of a control group does not allow a definitive judgment.

Digestive and Liver Disease, 2010

Journal of Clinical Medicine

Several studies have suggested the potential role of Magnesium Sulfate (MgSO4) for the treatment ... more Several studies have suggested the potential role of Magnesium Sulfate (MgSO4) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of magnesium is not standardized although it is largely used for the treatment of supraventricular arrhythmias. Objectives. We evaluated the role of MgSO4 infusion in association with flecainide in cardioversion of patients presenting in ED with symptomatic AF started less than 48 h before. We retrospectively searched for all patients presented in ED from 1 January 2019 to 31 December 2019 requiring pharmacological cardioversion with flecainide 2 mg/kg. Ninety-seven patients met these criteria, 46 received the administration of intravenous MgSO4 2 gr (Group A), and 51 did not (Group B). Among the 97 patients, the overall cardioversion rate was 85.6%, 91.3% in Group A and 80.4% in Group B. In 27 patients out of 97, the Flecainide was not administered because of spontaneous restoration of sinus rhythm of 9 pts (Group B) and 18 ...

International Journal of Clinical Practice, 2021

The COVID‐19 pandemic represents a source of stress and potential burnout for many physicians. Th... more The COVID‐19 pandemic represents a source of stress and potential burnout for many physicians. This single‐site survey aimed at assessing perceived stress and risk to develop burnout syndrome among physicians operating in COVID wards.

Digestive and Liver Disease, 2010

Internal and Emergency Medicine, 2021

Introduction Antibody response plays a fundamental role in the natural history of infectious dise... more Introduction Antibody response plays a fundamental role in the natural history of infectious disease. A better understanding of the immune response in patients with SARS-CoV-2 infection could be important for identifying patients at greater risk of developing a more severe form of disease and with a worse prognosis. Methods We performed a cross-sectional analysis to determine the presence and the levels of both anti-SARS-CoV-2 IgG and IgA in a cohort of hospitalized patients with confirmed infection at different times in the natural history of the disease. Patients enrolled when admitted at the emergency department were prospectively followed up during hospital stay. Results Overall, 131 patients were considered with a total of 237 samples processed. Cross-sectional analysis showed that seroconversion for IgA seems to occur between days 6 and 15, while IgG response seems to occur slightly later, peaking at day 20 after symptoms onset. Both IgA and IgG were maintained beyond 2 months. Severe patients showed a higher IgA response compared with mild patients when analyzing optical density (8.3 versus 5.6, p < 0.001). Prospective analysis conducted on 55 patients confirmed that IgA appear slightly earlier than IgG. After stratifying for the severity of disease, both the IgA and IgG responses were more vigorous in severe cases. Moreover, while IgG tended to stabilize, there was a relevant decline after the first month of IgA levels in mild cases. Conclusion IgA and IgG antibody response is closely related, although seroconversion for IgA occurs earlier. Both IgA and IgG are maintained beyond 2 months. Severe patients showed a more vigorous IgA and IgG response. IgA levels seem to decline after 1 month since the onset of symptoms in mild cases. Our results should be interpreted with cautions due to several limitations in our study, mainly the small number of cases, lack of data on viral load and clinical setting.

IntroductionAntibody response play a fundamental role in the natural history of infectious diseas... more IntroductionAntibody response play a fundamental role in the natural history of infectious disease. A better understanding of the immune response in patients with SARS-CoV-2 infection could be important for identifying patients at greater risk of developing a more severe form of disease and with a worse prognosis.MethodsWe performed a cross-sectional analysis to determine the presence and the levels of both anti-SARS-CoV-2 IgG and IgA in a cohort of hospitalized patients with confirmed infection at different times in the natural history of the disease. Patients enrolled when admitted at the emergency department were prospectively followed up during hospital stay.ResultsOverall, 131 patients were considered with a total of 237 samples processed. Cross-sectional analysis showed that seroconversion for IgA seems to occur between days 5 and 15 while IgG response seems to occur slightly later, peaking at day 20 after symptoms onset. Both IgA and IgG were maintained beyond two months. Sev...